Friday, 28 October 2011

From Hans Rosling’s surprise hit TV show The Joy of Stats to visual snapshots of the numbers in the news, there seems to be a new love affair with statistics, especially when they come in a graphic form that can be grasped intuitively. It doesn’t take a maths degree to see that a straight line sloping upwards suggests a relationship between the height and age of schoolchildren, for example, or that a large blob represents more murders than a smaller blob. We are ready, perhaps too ready, to give credence to statistics, which appear to manifest the mysterious labours of the mathematically literate in transparent, self-explanatory form. We too rarely question the assumptions that underlie the figures, and too often forget that an evident correlation between two things – US oil production and the quality of rock ‘n’ roll, for example – does not necessarily mean there’s a causal relationship. And we are often beguiled into believing that the past automatically predicts the future – a graph which shows anything increasing exponentially in the past can only spell doom for the future.

We need statistics. By collecting lots of simple information in numerical form we can see patterns that may help us understand problems and spot underlying causes. But this is where things get tricky. If the number of Elvis Presley impersonators continues to increase as it did from 1957 (170 worldwide) to 2007 (over 85,000 worldwide) one in three of us will be Elvis impersonators by 2019. Is this likely? Public health and economics, among other disciplines, rely on modelling human behaviour the same way animal behaviour, or the behaviour of water molecules, can be modelled: by looking at what they’ve done so far. Not surprisingly, this leaves the predicted future looking very much like the past. But people are not data points, and both individuals and societies can behave in unpredictable ways. You can calculate your probability of living to be 100 (one in six of the current UK population) but that’s an educated estimate of the odds, not a guarantee. Are we in danger of turning statistical modelling from a useful analytical tool to the new astrology?

Speakers

Timandra Harkness
journalist and writer; co-writer and performer, Edinburgh Festival Fringe smash hit Your Days Are Numbered: the maths of death

Wednesday, 26 October 2011

A letter in this week's British Medical Journal has been press released around the world and may feature in today's newspapers. Although it appears to have been written by a precocious child, it is actually from the pen of a grown man, and a doctor at that.

The letter is actually an online comment to an article in the BMJ from last month. The BMJ must have been so impressed by its startlingly original contents that it deemed it worthy of a wider readership.

Excuse my naivety, but isn’t smoking’s continued legality one of the most important factors accounting for its slow rate of decline?

If you mean that fewer people would smoke if smoking was illegal, then yes, but it's not quite as simple as that, is it?

Any other drug causing a fraction of the morbidity and mortality of tobacco would have been outlawed long ago, putting aside alcohol for the moment.

Why should we put aside alcohol? Perhaps because it doesn't fit your argument?

In 2010 mephedrone became a class B drug following widespread media coverage and reports of some deaths in the preceding months, although the evidence surrounding the dangers of mephedrone does not exist.

I agree. Mephedrone should not have been banned, as I argued in The Art of Suppression. Unfortunately, we live in prohibitionist times and there is no greater engine of prohibition than the public health establishment, as epitomised by the British Medical Journal.

This is in stark contrast to tobacco, which is responsible for around 100,000 deaths each year in the UK. Why should smoking get special treatment?

I suppose because 1.5 billion people worldwide like consuming tobacco and people can function perfectly well under the influence of nicotine in a way that they can't under the influence of party drugs and amphetamines. The majority of people believe smoking should be legal so it is. We call it democracy and, in a free society, informed adults have a right to put what they like into their bodies even if it carries a risk to their health. The question is not why should smoking get special treatment, but why shouldn't drugs be legal?

For mainly economic and political reasons, adults with enough change in their pocket can walk into their local shop and buy a packet of cigarettes. They will not be judged and will not feel ashamed: smoking is an acceptable addiction.

If that is true - and broadly speaking, it is - it is not for want of trying from the denormalisers of public health. Every effort is made by alleged health campaigners to stigmatise smokers, demonise tobacco and villify the manufacturers. If this hate campaign has not yet led to actual lynch mobs, it only shows that the general public are more tolerant than the British Medical Association. That, again, answers your question as to why smoking remains legal.

If the tabloid press were to publish a list of the names of the more than 250 people killed by smoking related disease each day, would the government be as fast to react as it did for mephedrone?

[splutter]

[wipes coffee from keyboard]

Assuming this to be a serious suggestion, I will attempt a serious reply. Leaving aside the extraordinary distastefulness of the idea and the unconscionable invasion of privacy, the main problem is that such a scheme would be impossible to carry out. No one is able to name these hypothetical 250 people because doctors and coroners very rarely list smoking as a cause of death. Although the BBC recently affected shock at the reluctance of doctors to name smoking on death certificates, all smoking-related diseases are multi-factoral (ie. have more than one cause) and all smoking-related diseases can be contracted by nonsmokers.

So while there is a good chance that a smoker who dies of lung cancer developed the disease because of his smoking, there is a chance that he would have got it even if he had not smoked. In the case of heart disease - which is the biggest contributor to the 100,000 figure - it is impossible to say that smoking was the cause of any one death. This lack of certainty in individual cases is the main reason why personal injury lawsuits against tobacco companies tend to fail in court.

Imagine a fat smoker with a family history of heart disease, a poor diet and a stressful job. Can a doctor say with any certainty that his heart attack was 'caused' by his smoking, his diet, his stress, his genes or his diet? It can't be done. The 100,000 figure comes from assumptions taken from the epidemiological literature based on aggregate data from hospitals. It is an estimate. It is not based on a running total of clinically proven 'smoking-related deaths'.

Even if such a list could be created, who is going to pay for the column inches in the tabloids every day? Since this letter was written by an authoritarian doctor of public health, we must assume that the taxpayer will, as ever, be expected to foot the bill. And why only tabloids? Are we to assume that smokers do not read the broadsheets?

Finally, on a practical note, the great majority of the 250 daily deaths would be of people in their 70s, 80s and 90s. Smoking prevention campaigns are largely targeted at people in their teens and twenties. It is doubtful whether listing the names of people who, for the most part, enjoyed the proverbial 'good innings' is really going to have desired the shock value for the target group of devil-may-care youngsters.

People’s attitude towards drugs should be evidence based, and not informed by politics or popular opinion.

Quite so. Let's legalise them. Prohibition didn't work with alcohol, it doesn't work with drugs and it won't work with tobacco.

How must smokers feel when they are encouraged to quit their habit by the same government that welcomes tobacco taxes so gladly?

I suppose it makes them think that politicians are greedy hypocrites. A valuable lesson learned, no?

While smoking remains legal, the number of smokers is never going to fall significantly—no matter how much taxes rise, how plain cigarette packets become, or how many millions of pounds is spent on cessation.

Smoking rates have actually fallen very significantly over the years and may continue to do so. Admittedly, they have flat-lined since 2006, when the government began listening to the 'experts' of tobacco control and introduced divisive, ill-considered policies like total smoking bans, graphic warnings and display bans. Maybe the politicians will learn their lesson and withdraw their funding from astro-turf anti-smoking groups in the same way as it has recently stopped funding Alcohol Concern. (Rather than try and raise money from the general public, Don Shenker has realised that the game is up and has resigned. Cheers!)

Perhaps the smoking rate will continue to flat-line. Or it might start going back up. Or it might fall again. Who knows? It's none of your business and it's none of mine either. The risks of smoking are universally acknowledged and there is a great big warning on every pack saying 'Smoking Kills'. Having accepted that prohibition doesn't work, we must also accept that informed adults have the choice to smoke or not smoke. There really isn't more to say on the matter. You live your life and I'll live mine.

As I mentioned, this letter may be the subject of some news coverage today, presumably because it raises the spectre of the 'next and final step'. I'll be on BBC Radio Sussex at around 9.50am talking about it.

Tuesday, 25 October 2011

A day might come when I get sick of reminding self-righteous nonsmokers that the anti-tobacco campaign was only a template for a larger war against every pleasure, but that day is not today.

"It's only smoking," they squealed. "Alcohol, food and fizzy drinks are completely different." Not to the British Medical Association they're not, nor to the Royal College of Physicians, the Surgeon General nor Kelly "wide load" Brownell who writes the op-ed below. Sit back and enjoy how the gluttonous soda tax campaigner draws a direct parallel between Coca-Cola and British American Tobacco. Are we getting the message yet?

Meet Big Soda — as Bad as Big Tobacco

Subtle enough for you?

...But the beverage industry, dominated by Coca-Cola and PepsiCo, and represented by the American Beverage Association, has exercised its might against this public health initiative in ways reminiscent of the tobacco industry when it came under attack in the 1950s. The beverage industry argues that such taxes are “discriminatory” in singling out one category of food, that taxes would not work, and that government should not tell people what to eat. The tobacco industry said taxes would not work (they did work — tremendously well) and that government should stay out of people’s choice to smoke.

Similar to tobacco companies, the soda industry has created a front group, Americans Against Food Taxes, to run anti-tax campaigns (a Super Bowl ad, for example). The name of the group implies a patriotic, grass roots movement, not a highly financed entity initiated and organized by industry. The tobacco industry paid scientists who did research disputing links between smoking and lung cancer, the addictive nature of nicotine, and the dangers of second-hand smoke. The soda industry funds scientists who reliably produce research showing no link between SSB consumption and health. The tobacco industry bought favor from community and national organizations by giving large donations. In an ironic twist, Coca Cola and PepsiCo are corporate sponsors of the American Dietetic Association.

Over time, the tobacco companies were outed for their dirty tactics...

And so on and so. You can read the whole thing here. There are soda taxes in more than thirty US states. Hungary and Denmark already have fat taxes. The British Medical Association says it's "time to denormalise drinking". Squeal on suckers. Like it or not, we're all smokers now.

Saturday, 22 October 2011

Scotland's dreadful health secretary Nicola Sturgeon has been banging the drum for minimum alcohol pricing policy at a SNP conference. As with plain packaging in Australia, the opportunity of attracting some media attention from an otherwise indiffernt world is the pathetic carrot being dangled.

The 1,300 gathering heard Ms Sturgeon say: "Delegates, I can tell you today that our minimum pricing bill will be reintroduced to parliament within the next month.

"When that bill is passed, Scotland will become the first country to introduce a minimum price per unit of alcohol. The world is watching us."

Not so much "when" as "if", since minimum pricing is almost certainly illegal under EU law. Rather than wasting time and money on this doomed policy, the Sturgeon General should listen to expert opinion, like this report from Rand Europe.

Minimum prices for alcoholic beverages, also sometimes called Social Reference Prices, are used in different ways in a number of areas outside the EU, including several Canadian provinces (Saskatchewan, Ontario, Newfoundland, New Brunswick, etc) where the regulation applies to licensed on-trade premises (Strang 2008).

But while a recent Scottish expert consultation concluded that minimum pricing is possible under EU competition law, ‘provided that minimum prices are imposed on licensees by law or at the sole instigation of a public authority’ (SHAAP 2007), minimum pricing practices have tended to be seen as trade-distorting by the European courts (as setting an artificial price floor amounts to resale price maintenance, limiting and distorting price competition), and therefore not typically put in place in the EU (Baumberg and Anderson 2008).

Minimum prices had also been considered, and even introduced through legislation in a few Member States such as Austria and Ireland, for cigarettes as a public health measure, but these moves were contested by the European Commission. This was in line with the jurisprudence of the European Court of Justice, which considers that minimum prices infringe Community law, distort competition and benefit manufacturers by safeguarding their profit margins.

Council Directive 95/59/EC states that manufacturers and importers of tobacco products have the right to determine the retail selling price of their products; according to ECJ jurisprudence minimum prices impair this right and are therefore not compatible with this Directive. The ECJ also stated that minimum prices are not necessary since their health objectives can be achieved through increases in taxation.

This report was commission by the European Commission and the sources given in this particular section include "personal communication from European Commission Directorate General Competition official."

Friday, 21 October 2011

Campaigners build themselves into a self-righteous position from which they cannot climb down, fuelled by selectively interpreted science. ‘Moral entrepreneurs’, lacking in empathy for their fellow man, forge a career for themselves, glorying in their political and financial successes. For success breeds success and their relentless proselytising finds willing adherents. Government is attracted by the sense of decisiveness attached to prohibition. And the general public is guilty as well, our neighbourly intolerance lending widespread popular support to bans.

Prohibitionists find willing allies in the commercial rivals of those producing the product in question. Brewers supported the early US temperance movement, hoping to damage distillers. Modern pharmaceutical companies fear that the rise of tobacco substitutes like snus will undermine the market for nicotine patches.

Yet for all this, prohibition is doomed to founder on the rock of human desire. It is in our bones to seek out physical pleasure, sometimes at considerable cost. “When the law cuts off one avenue of pleasure, new sources are invariably found,” as Snowdon puts it. If there is any great demand for a certain product, be it food, drink, drugs or sex, then the risks of purveying it are met by colossal rewards.

The Art of Suppression is full of great facts – its description of opium-addicted Britain before the wars is particularly memorable. But its real impact is its pithy denunciation of the prohibitionist cause. It ends with a modest proposal for a more practical and tolerant approach to drugs of all kinds. In his modesty Snowdon does not hold much hope for implementation. But this book must make that goal more likely.

Thursday, 20 October 2011

Alcohol Concern have a habit of using children in their opinion polls, presumably because young people tend to be stupid and impressionable, and therefore more likely to support neo-prohibitionist policies.

A survey of over 2300 children and young people reveals concern at alcohol marketing exposure and support for stronger regulation that robustly protects under-18s, finds Alcohol Concern

People under 18 can't buy alcohol and they can't vote, so as far as I'm concerned they can keep their opinions to themselves. But if some of the quotes reprinted in the report are genuine, we might as well pack our bags now. The final triumph of the nanny state cannot be far off.

“[Alcohol products] should contain shocking images like the image you see on packets of cigarettes, as you do not actually see how ill people can get from alcohol”

Female, 15 years-old

However, there are good reasons to doubt whether this survey is reliable.

The survey was disseminated via a targeted email (to youth groups, schools, local-authority youth services and interested individuals) and published on the Alcohol Concern website and on Twitter.

Indeed it was. Here is the tweet announcing it to the world...

The only to people to see this tweet would have been those who follow Alcohol Concern on Twitter, which is to say a self-selecting sample of temperance folk, 'public health professionals' and people like me who like to keep an eye on them. The people who visit the Alcohol Concern website are likely to have a similar bias.

These people will be predominantly adults but they might encourage their children to complete the survey, perhaps with a little helping hand.

Or they might just pretend to be children and fill it in themselves. After all, as the survey found, it is not hard to bypass online age checks...

Alcohol websites ask you to enter a date of birth to prove you are not under-18. Is this enough to stop under-18s from visiting these sites?

No, it's easy to enter another date: 78.2%

Yes, this is enough to stop me: 16.6%

Indeed. And this equally applies to Alcohol Concern's online survey which was strictly for the under-18s but whose only age verification process was this:

The survey itself was designed by 13 to 18 year olds (seriously) and it shows. A professional polling outfit would not resort to leading the witness as blatantly as this survey does. Take the introduction to the survey, for example (no longer online, but saved here):

Alcohol companies spend over £800 million each year in the UK on advertising (ads) to increase sales of their product. Under existing rules young people under 18-years-old should be protected from seeing most alcohol ads, but many studies show this isn't the case.

Today, advertising use technoloy to reach us in lots of different ways, like: TV; radio; cinema; billboard/posters; the internet; via mobile phones; through the sponsorship of music festivals and sports events; and even on football shirts... along with many other avenues.

You don't think all this talk of rampant alcohol advertising ("even on football shirts"!) and rules being breached could plant ideas in the respondent's mind, do you?

The Youth Policy project specifically chose not to detail the existing alcohol-promotion regulations to The Voice or to survey participants, wanting to capture their expectations of alcohol-promotion regulation based on what young people see and hear around them.

These are weasel words. It is true that the survey doesn't "detail" the policies. Instead, it misrepresents them. Existing rules do not say that under-18s should be "protected" from seeing alcohol ads; it says that these ads must not target the under-18s. That is a big difference.

The report (and accompanying press release) emphasises in shocked tones that young people do not even recognise alcohol marketing when they see it.

The survey findings suggest that large numbers of young people regularly do not recognise alcohol marketing when it is channelled through sponsorship, product merchandise or via social networking sites – non-media channels known as ‘below the line’ promotion. Approximately half of young people do not consider alcohol promotion via such mediums as ‘marketing’, a finding which is consistent across both genders and all ages. This is of particular concern because investment in such strategies is increasing and is central to the alcohol industry’s efforts to associate with youth culture.

• 51.4% do not recognise official alcohol product Facebook groups as marketing

• 51.7% do not recognise alcohol branded events, such as festivals, as marketing

• 49.6% do not recognise alcohol sponsorship of football team shirts as marketing

• 49% do not recognise alcohol product merchandise as marketing.

The Guardian leads with this appalling insight into the ignorance of the young:

Most young people would like more protection from alcohol advertising, but under-18s do not recognise that drink logos on football shirts are a form of marketing, according to a survey.

This is extremely misleading. The question in the survey does not use the word 'marketing'. It uses the word 'ads'. Advertisements are clearly not the same thing as sponsorship, having a website or merchandising. All are forms of marketing, but they are not all forms of 'ads'. The actual question posed was:

Which of the following do you consider to be alcohol ads? (Tick as many boxes as you like)

• A viral video for an alcohol product

• Joining a Facebook group for an alcohol product (e.g. Smirnoff Facebook group)

So, if you don't consider sponsorship to be an ad—which it isn't—or if you don't consider joining a Facebook group to be an 'ad'—which doesn't even make sense—then Alcohol Concern assume that you also don't think these things constitute marketing—which they are. This, they say, "is of particular concern."

Alcohol Con, on the other hand, are acutely aware of the difference between advertisements and marketing, which is presumably why they used the word 'ads' in the survey and the word 'marketing' in the report and press release. This sleight of hand is brushed over in the text of the report, which says...

"the term ‘ads’ was inserted by The Voice to encompass ‘marketing’, ‘advertising’ and ‘promotion’ as the group felt that these terms meant the same thing to most young people."

Well, it doesn't, and not all kids are as thick as the ones who allegedly designed this survey. The change from 'ads' in the survey to 'marketing' in the final report must be regarded as highly suspect.

And finally, just in case the respondents hadn't quite worked out what the pollsters wanted to hear, the last question in the survey was:

Would you like to be kept informed of a youth led campaign that will challenge Government to reduce the amount of alcohol advertising we see?

No hint of a bias there then. Considering the standard of the survey, we can perhaps take heart that the majority of respondents still opposed Alcohol Concern's desired policy of a total ban on alcohol advertising on billboards, television and cinema.

Although the evidence suggests that a total ban on alcohol advertising would significantly reduce youth drinking, the majority of young people surveyed are not supportive of such strong regulatory intervention.

It also interesting that the under-11s were much keener or bans than the 16-17 year olds. Which just goes to show that neo-prohibitionism is a childish ideology that most people grow out of.

Keep New Zealand Beautiful national programme manager Tracy Shackleton said KiwiRail had requested the bins.

Oh.

"If a company rings up and requests the bin, we will, of course, oblige."

Right.

KiwiRail passenger general manager Deborah Hume said the company was not aware of the connection with British and American Tobacco.

So now what happens?

However, it agreed to accept the bins in order to address a litter and safety issue "and that still stands".

I see.

Erm...

What was the problem again?

West Coast Tobacco Coalition chairwoman Anne Hines, in a letter to the head of KiwiRail, said butt bins normalised smoking.

Of course, it's an issue of denormalisation. There was I thinking that litter was a problem that could be alleviated with litter bins, but I forgot when when tobacco is involved the only solution is the stigmatisation of its users and the total eradication of cigarettes. How silly of me, and how silly of the train company to have made the same mistake.

The bins normalised smoking, and allowed tobacco companies to claim social responsibility, she said.

Actually, what 'normalises' smoking is all the smokers hanging around smoking after being forbidden from smoking for their entire train journey. And since, as already mentioned, the press release did not mention the tobacco company, they can hardly be accused of claiming social responsibility. Nevertheless, social responsibility is what we would call it from any other industry.

They did nothing to encourage people to stop smoking, which would reduce the number of discarded cigarette butts.

This may come as a shock to you, Anne, but not everything in the world is designed for the purposes of social engineering. However abnormal you may view the habit, 20% of New Zealanders continue to smoke and they do so in an increasingly limited number of places. In your excitable imagination, abolishing cigarette bins in designated smoking areas will make smokers think "there's nowhere to put this, I'd better give up smoking now", but here in the real world a lack of cigarette bins leads to lots of cigarette litter. If tobacco companies pay for some cigarette bins, the financial burden is shifted from the taxpayer to the smoker (because, of course, smokers fund the tobacco companies). This is an equitable solution to a negative externality. So, really, what is the problem?

The truth is that tobacco controllers like Ms Hines don't like cigarette bins because they are practical solutions to a simple problem. They prefer to deprive smokers of somewhere to put their litter and then portray them of being inconsiderate, socially irresponsible litter bugs. Like all neo-prohibitionists, they create a problem—in this instance, banning smoking in every indoor place and then abolishing cigarette bins outdoors—and then blame other people for the inevitable consequences.

Cigarette litter is a useful weapon to use against smokers, particularly now that outdoor smoking bans are a priority. A staggering amount of junk research has been produced on the topic this year alone (have a look). Take this article from the anti-smoking comic Tobacco Control for example. It encourages advocates to make alliances with environmental groups to capitalise on the cigarette litter 'problem' while attacking the tobacco industry for having the temerity to support tidy-street programmes. As with the New Zealand "news story", the article contains scandalous "revelations" about cigarette companies which don't exactly set the heart racing.

The tobacco industry has been concerned about cigarette butt litter as an issue since the 1970s; a 1979 Tobacco Institute memo stated that smokers’ ‘careless, offensive and occasionally harmful’ cigarette butt disposal practices were contributing to the declining acceptability of smoking. A decade later, the industry was concerned about the ‘potential for anti-smoking groups to seize [the litter] issue to attack cigarettes’.

They got that right then, didn't they? How very prescient.

The tobacco industry has responded to the litter issue through partnership with Keep America Beautiful (KAB), an anti-litter organisation.

Yet more secret funding and backroom dealings?

Er, no...

The industry has made no secret of its ties to KAB and similar organisations

Well, fine. Why should they? Cigarette butts are an important source of litter, as tobacco control groups are constantly telling us. So, what is to be done?

In other words, treat cigarette litter the same as every other form of litter. Sounds fair enough. Other industries are expected to encourage responsible disposal of waste, why not the tobacco industry? The answer, apparently, is that...

Like secondhand smoke, litter is a consequence of smokers’ behaviour; the industry has no direct control over it.

That's rather contentious, to say the least, and also flatly at odds with the following sentence...

The tobacco industry has managed the litter issue to its advantage by blaming it on individuals and - as with other issues, including tobacco-related disease - denying its own responsibility.

So which is it? Is cigarette litter the result of individual behaviour which the industry has no control over, or is the industry responsible for cigarette litter while blaming helpless individuals? Or do the authors of this article have no coherent argument at all?

Industry-preferred ‘solutions’ to the litter problem are smoker education, installation of permanent ashtrays and distribution of pocket ashtrays. Although they implicitly blame smokers for litter, these approaches also enable smokers to keep smoking despite increased restrictions and declining social acceptability.

I case you hadn't noticed, smokers are able to smoke regardless of whether there are permanent ashtrays and do so in abundance. It's not a choice between a world with cigarette bins and a world of mass abstinence. It's a choice between lots of cigarette litter and less cigarette litter. The "industry-preferred" solutions are identical to governmental solutions used for every other form of litter: education and the provision of disposal units. No one would seriously argue that removing litter bins from the streets would result in the abolition of rubbish, so what makes cigarette butts any different?

The authors then proceed to give tips on how anti-smoking campaigners can infiltrate environmental groups on the pretext of being concerned about litter while actually pushing an abstinence-only message.

Allies should reach mutual understanding about the nature of the problem. An organisation focused on ‘litter ’ might regard ashtray installation as a reasonable solution.

No kidding. But what do they know, eh? As far the experts from Tobacco Control are concerned, these organisations are deluding themselves (and probably in the pay of Big Tobacco), so they need to be re-educated by the Johnny-come-latelys of the anti-smoking movement.

The environmental principles ‘reduce, reuse, recycle’ should be foregrounded, ensuring that smoking prevention and cessation (ie, ‘reduce’) are considered fundamental.

That's right. Anti-smoking campaigners—who are not in the least bit interested in littering as an issue—are going to alter the decades-old environmental message of "reduce, reuse, recycle" and turn it into "reduce, reduce, reduce." The hubris of these people beggars belief. Take this gem of an idea, for example...

Legislation could require that a sealable return envelope be included with each pack sold, that retailers only accept returns in those containers

Recycling mandates and waste mitigation regulations are not ordinarily designed to curb use...

You're right. They're not, but a handful of monomaniacs briefly and disingenuously joining the environmental movement can change all that, right?

However, if laws requiring cigarette retailers to accept butts back for recycling cause them to stop selling cigarettes, this would also be a gain for tobacco control.

Amongst the many problems with this three-o'clock-in-the-morning idea is that the waste involved in manufacturing envelopes to be sold with every pack of cigarettes, combined with the energy used in posting cigarette butts around the world for no useful purpose, is far more environmentally destructive that a few butts on the pavement. And since the aim of this plan is explicitly to inconvenience smokers and shop-keepers, I suspect that even the looniest green activist will be happy to forego this "gain for tobacco control".

The authors also see a chance to pursue their usual objective of upping the price of cigarettes and limiting availability. If you've got a hammer, everything looks like a nail.

Waste mitigation programs may also raise the price of cigarettes, a well-established means of reducing smoking prevalence rates, and reduce the number of retailers willing or qualiﬁed to sell particular goods.

And the madness keeps on coming...

One idea that has not been tried is banning cigarette filters.

[splutter]

Filters have not been shown to reduce the harms of smoking.

Actually they have been shown to reduce the harms of smoking (I could write a whole post on this subject if anyone's interested). Filters are probably the only innovation in cigarette design to have helped reduce the harms of smoking in a century of searching, and yet here are alleged health campaigners recommending their abolition.

So let's get this straight. On the pretext of protecting public health, cigarettes need to be made more dangerous. On the pretext of environmentalism, countless trees need to be cut down to manufacture billions of pointless envelopes. On the pretext of reducing cigarette litter, smokers need to be deprived of litter bins.

Friday, 14 October 2011

Further to Monday's post about the childhood asthma rate in Scotland, it is worth comparing the data presented by Jill Pell in her NEJM paper—which claimed there were 18% fewer hospital admissions after the smoking ban—with the actual hospital admissions data recorded by the Scottish NHS.

This is the "smoothed" graph presented by Pell in her study, which as noted in a previous post, does not even fit her own data. (The last 'year' shown is also not a full year.)

Pell's study produced the intended flood of media coverage, of which this Reuters report was typical.

Scottish smoking ban cuts childhood asthma attacks

A 2006 public smoking ban in Scotland reduced the number of serious childhood asthma attacks by 18 percent per year, researchers reported on Wednesday.

Before the ban imposed in March 2006, the number of hospital admissions for asthma was rising by 5 percent a year among children under 15. The after-ban benefits were seen in both pre-school and school-age children.

Critics had said the ban could force smokers who could not light up in the workplace or in enclosed public spaces to smoke more at home, increasing the risk to children.

Dr. Jill Pell of the University of Glasgow, who worked on the new study, said the findings in the New England Journal of Medicine show that did not happen.

"The evidence we have from Scotland is that it had the opposite effect. People are generally more accepting of the need to protect nonsmokers and vulnerable groups such as children," Pell said in a telephone interview.

"Children were being exposed to less secondhand smoke. We went into the study hoping we would see some health benefit coming out of that."

However...

NHS Scotland has since published the statistics showing how many children were admitted to hospital with asthma between 2005 and 2009. These figures can be viewed here. They do not support Pell's hypothesis in any way, shape or form.

The graph below shows the rate of hospital admissions for asthma for children aged 0-14 years in all Scottish hospitals (per 100,000). The years shown are financial years (April to March - the first year shown is 2005/06), which is useful since the smoking ban was introduced in Scotland at the end of March 2006. Each of the last four bars therefore represent a full post-ban year.

The next graph shows the total number of episodes of the same (ie. the absolute number of admissions). It naturally shows a very similar picture.

Although not discussed by Pell, it is interesting to note that the rate of asthma admissions amongst people of all ages has been higher in every year since the smoking ban was introduced.

And, for good measure, let's have a look at hospital admissions for all diseases of the respiratory system combined.

The data available online do not go back further than 2005/06 so we cannot see the long-term trend earlier in the decade. However, it is sufficient to see that there was no decline in hospital admissions for any of these diseases amongst any age group. If anything, there was an increase.

So, once again, you have a choice. You can choose to believe Jill Pell, a researcher who has, shall we say, "form" when it comes to producing studies like this.

Or you can believe the statistics produced by NHS Scotland which are based on the number of people who actually got admitted to hospital. These statistics, incidentally, support the claim made by Asthma UK that the rate of childhood asthma has remained essentially static for a decade.

Thursday, 13 October 2011

Two studies have recently been published testing the efficacy of snus and e-cigarettes in smoking cessation.

In the Harm Reduction Journal, Joksic et al. report their results from a randomised, placebo-controlled, double-blind trial in which 158 smokers were given snus and 161 smokers were given a placebo. Smoking status was verified throughout with carbon monoxide tests and 81% of participants enrolled because they wanted to quit smoking.

The results show that the snus-users were three times more likely to reduce their cigarette consumption by more than 75% and were two to three times more likely to quit smoking entirely.

An interesting feature of the study is that it was conducted in Serbia, which has no history of snus use. It is sometimes said that snus is a quintessentially Swedish habit that could never take off in the rest of the world. This seems to me a rather odd and slightly xenophobic view (see Alan Blum's quote in The Art of Suppression!) but this success in Eastern Europe shows that the 'Swedish experience' can indeed be exported.

The e-cigarette trial had a smaller sample (of 40) and no control, but if its results are replicated elsewhere, things look very encouraging. At the end of the six months, 22.5% of participants had given up smoking entirely. Amongst all participants, average cigarette consumption fell from 25 a day to 5 a day. As Michael Siegel says, this compares very favourably with pharmaceutical nicotine products. The special point of interest in this study is that none of the participants expressed any particular desire to quit smoking at the outset.

You might think the anti-smoking movement would be jumping for joy at the prospect of having two effective smoking-cessation products to offer the public. As I write this, ASH Wales is holding a conference in Cardiff (with the temperance lobby, natch). It would be nice to think that they are celebrating the news that there are efficacious nicotine products to compete with Big Pharma's 'nicotine replacement therapies', but somehow I don't think they will be.

Wednesday, 12 October 2011

Reading Eric Crampton's excellent Offsetting Behaviour blog, I came across a post from last year discussing the health benefits of drinking alcohol. Eric provides a succinct summary of how alcohol research is presented to the public.

Every risk is conclusively proven; every benefit needs further study.

That's about the size of it. Of the benefits, there is research going back thirty years showing that the relationship between drinking and mortality is U-shaped or J-shaped, ie. risk is higher for total abstainers, lower for moderate drinkers and then rises again for heavy drinkers. This is largely the result of alcohol's protective effect on the heart. Reduced incidence of cardiovascular disease has been shown in many dozens of studies.

The correlations are consistent and (by modern epidemiological standards) fairly strong, but is there causation? If the popular media were any guide, you might think that the issue is shrouded in controversy. You may even believe that the J-shaped curve has been debunked.

The issue that is often raised is the "sick quitter" hypothesis—the idea that teetotallers are a sickly bunch who don't drink because they are chronically ill or because they have already destroyed their bodies with alcohol. In other words, alcohol doesn't protect health, it just so happens that teetotallers are unusually sickly.

David Nutt is a fan of this explanation, as are these Australians. I have seen Danny Dorling give this explanation on television. Ben Goldacre also uses it his book Bad Science (Unless it's for a Good Cause in Which Case I'll Look the Other Way):

Every time you read in a newspaper that 'moderate alcohol intake' is associated with some improved health outcome - less heart disease, less obesity, anything - you are almost certainly witnessing a journalist of limited intellect, overinterpreting a study with huge confounding variables.

This is because, let's be honest: teetotallers are abnormal. They're not like everyone else. They will almost certainly have a reason for not drinking, and it might be moral, or cultural, or perhaps even medical, but there's a serious risk that whatever is causing them to be teetotal might also have other effects on their health, confusing the relationship between their drinking habits and their health outcomes.

... Perhaps pre-existing ill health will force you to give up alcohol, and that's skewing the figures, making teetotallers look unhealthier than moderate drinkers. Perhaps these teetotallers are recovering alcoholics...

Well yes, perhaps they are. Who knows? If only someone would find out for sure...

Oh wait, they have. The "sick quitter" hypothesis was first put forward in 1988 and has been tested repeatedly in the last twenty years. The results of these studies showed that "sick quitters" do not explain the J-shaped curve.

Researchers have sought to address these concerns in several ways. Some epidemiological studies have separated former drinkers from long-term abstainers to address the sick quitter hypothesis. For example, in an analysis of 87,526 women, the risk of coronary heart disease was only 10 percent higher among former drinkers than among long-term abstainers (Stampfer et al. 1988).

Furthermore, the exclusion of former drinkers among the abstainers did not alter the 40 percent lower risk of coronary heart disease among women who drank 5.0–14.9 grams of alcohol (about 0.3–1 standard drinks) daily. Moreover, Rimm and colleagues (1991) found comparable risks of coronary heart disease among abstainers and light drinkers (i.e., people who consumed less than 5.0 grams of alcohol, or 0.3 standard drinks, daily) in their study of 51,529 healthy men, suggesting that abstainers are not an inappropriate reference group.

Other studies have excluded participants who developed coronary heart disease or died during the first few years of followup, as a means of excluding unidentified "sick" subjects, with similar results (Fuchs et al. 1995).

Taken together these findings indicate that the presence of sick quitters or former alcoholics among the abstainers is not responsible for the apparent benefits of alcohol consumption on the risk of coronary heart disease.

With other factors studied and discounted, the conclusion must be that alcohol has a protective effect on cardiovascular health. This, for example, from Rimm and Moats (2007):

A recent meta-analysis raised questions about systematic misclassification error in observational studies because of inclusion among “nondrinkers” of ex-drinkers and/or occasional drinkers. However, misclassification among a small percentage of nondrinkers cannot fully explain the inverse relation, and there is substantial evidence to refute the “sick quitter” hypothesis. Furthermore, it has been shown that moderate alcohol consumption reduces CHD and mortality in individuals with hypertension, diabetes, and existing CHD.

To address the issue of residual confounding by healthy lifestyle in drinkers, in a large prospective study we restricted analysis to only “healthy” men (who did not smoke, exercised, ate a good diet, and were not obese). Within this group, men who drank moderately had a relative risk for CHD of 0.38 (95% CI, 0.16–0.89) compared with abstainers, providing further evidence to support the hypothesis that the inverse association of alcohol to CHD is causal, and not confounded by healthy lifestyle behaviors.

Amongst those who studied the topic were Richard Doll and Richard Peto who concluded in 1997:

Thus, both in our study and in other studies that involved the observation of large numbers of deaths, confounding, in so far as it has been possible to test for it, does not seem to be responsible for the relatively higher vascular mortality in non-drinkers than in moderate drinkers. Hence we concur with the expert advisors to the European Office of the World Health Organization1141 that 'drinking modest amounts of alcoholic beverages is likely to reduce the risk of CHD [coronary heart disease] for some populations'.

Once of the more recent studies (Holahan et al., 2010) confirmed that alcohol's protective effect is independent of other factors.

Controlling only for age and gender, compared to moderate drinkers, abstainers had a more than 2 times increased mortality risk, heavy drinkers had 70% increased risk, and light drinkers had 23% increased risk. A model controlling for former problem drinking status, existing health problems, and key sociodemographic and social-behavioral factors, as well as for age and gender, substantially reduced the mortality effect for abstainers compared to moderate drinkers. However, even after adjusting for all covariates, abstainers and heavy drinkers continued to show increased mortality risks of 51 and 45%, respectively, compared to moderate drinkers.

This is what science is supposed to do. It asks questions of the data and tests plausible alternative explanations. The sick quitter hypothesis has been tested to death. It does not explain the J-shaped relationship between alcohol consumption and mortality.

Overall, even the most vociferous of critics agree that alcohol taken in light-to-moderate quantities, preferably regularly and with meals, appears to favourably affect ischaemic heart disease.

To ask questions of the data is right and fair. But to keep raising those questions after they have been answered makes me suspect you have an agenda. For some people, the potential of the sick quitter hypothesis to overturn the science was too good to be dropped even after it was disproved.

The modern literature (ie the last 4 years) seems to have thoroughly answered the critiques raised in the early 2000s about potential confounds in the J-curve. The worries about potential confounds were plausible: if "never drinkers" and "people who quit drinking because their health was terrible" were coded similarly in the data, that could produce a J-curve without any health benefits from moderate drinking. But that just wasn't what was going on in the data. It's been resolved.

Why won't this zombie argument lie down and die? The answer, I think, is that the temperance lobby hates the fact that total abstinence is not the optimal position and the public health establishment is always uncomfortable with nuanced advice. Advising moderation is fine for GPs, but politically active doctors and neo-prohibitionists prefer to frame things in terms of 'healthy' or 'unhealthy', 'good' or 'evil'.

I think it likely that within a few years the official advice will be to drink no alcohol at all. This would bring it in line with the World Health Organisation's absurd claim that there is no safe level of drinking.

The key message was that no safe level of drinking exists, so people should talk about levels of risk and drop terms such as “safe drinking”, “sensible drinking” and “alcohol misuse”.

This would be bad scientific advice and very probably bad medical advice, but what the hell? We can't have people seeing alcohol as anything other than an unmitigated evil can we?

As I recount in The Art of Suppression, American teetotallers scored a crucial victory when they persuaded the public that alcohol was a poison that could never be consumed in moderation. This was a lie then and it is a lie now, but it pathed the way for Prohibition. Moderation is the enemy of the zealous. Expect to hear much more about how the J-curve has been "debunked" in the years ahead.

Tuesday, 11 October 2011

On Thursday, I mentioned Stanton Glantz's latest contribution to the SmokeFree Movies campaign when he published a study which found that films that showed smoking make 13% less at the box office than 'smokefree movies'.

To give Glantz his due, he did not fall into the trap of mistaking correlation with causation in the study itself.

Fear not, dear reader. Even Stan is not prepared to mistake correlation and causation so grievously (although it surely won't be long before advocates use this study to tell Hollywood: "Get rid of smoking in your films and you'll boost sales by 13%"). He does not claim that smoking in films is the cause of lower revenues. He does not explore what the actual reasons may be, but it seems likely that smoking is more common in indie films, gritty dramas, European releases and other movies which tend to make less money than big budget cartoons and family blockbusters.

I did, however, ask how long it would be before some dumb-bell took the study as 'proof' that putting smoking in a film directly leads to fewer people going to see it and, therefore, making less money.

Research into the care of young people with asthma has exposed "shocking" complacency by some Scottish health boards, according to charity Asthma UK.

Asthma UK said the number of emergency admissions had remained unchanged for a decade - suggesting the asthma of many young people was still being badly managed.

Asthma UK Scotland's national director Gordon Brown said: "This report makes shocking reading - especially when you consider Scotland has one of the highest rates of childhood asthma in the world.

"Some health boards are doing some things very well - and this is down to the excellent staff within managed clinical networks.

"However, it seems that at a strategic level some complacency has crept in - that asthma has somehow been 'fixed' and priorities have now changed.

"This is borne out by the fact there has been no noticeable change in the unacceptably high emergency hospital admissions for children and young people with asthma in the last decade."

It is impossible for both these statements to be true. Either emergency hospital admissions for children with asthma fell by 15% after the smoking ban or they have remained unchanged for a decade. Someone's not telling the truth. Is is the "study by Glasgow University" or Asthma UK?

You can probably guess the answer. If I told you that the Glasgow study was penned by the infamous Jill Pell, you would be in no doubt at all.

Readers with a long memory will recall that Pell's study was the sheerest junk science. There was no effect from the smoking ban on asthma admissions. In fact, the first year of the Scottish smoking ban saw the largest number of childhood asthma admissions of the decade. Asthma UK is correct. Pell is wrong. Again.

Here we have two 'facts' which are totally at odds with each other appearing on the same news website in the same year. One fact is the number of children who actually went to hospital with asthma. The other is a piece of statistical jiggery-pokery created for political ends. And yet only one of them is true. The other is a fraud which has taken the place of the truth thanks to repetition and the appeal to authority (it was published in the prestigious, peer-reviewed New England Journal of Medicine). The real truth, meanwhile, appears almost by accident in a different context and no one at the BBC makes the connection.

This is the parallel universe created by the charlatans of the anti-smoking industry. They are entitled to their own facts. Whether or not they are true is of no consequence. They want them to be true and that is all that matters.

It is ridiculously easy to see through this garbage. The real hospital admissions data for asthma are available online, just as the heart attack data are. It takes a matter of minutes to distinguish fact from fiction and yet there is only silence and tumbleweed. If the mainstream media do not feel inclined to expose blatant policy-based evidence when it is in its crudest form, what hope is there of more subtle scientific abuses coming to light?

Smoking will be once again permitted in Greece given the country’s poor financial situation [but smoking bans are good for business! ASH says so]. The new measure will allow smokers to smoke inside casinos and big nightclubs exceeding 300m2.

According to the decision of Finance and Health Ministers, Mr. Venizelos and Mr. Loverdos, casino and big nightclub owners will be authorized to set up a smoking area, which could cover 50% of the total acreage of their business.

While most people are obliged to freeze on the pavement to keep up their cigarette habit, since the ban was introduced three years ago, a growing number of nightspots are offering exclusive and law-abiding shelter for smokers, complete with pianos, leather armchairs, and cigar lockers.

French law still allows indoor smoking spaces provided they have state-of-the-art ventilation and that no staff operate inside.

Consenting adults making grown up decisions for themselves — could this radical idea ever catch on?

This all comes after the Netherlands, Germany, Croatia, Portugal, Belgium, Denmark, Macedonia, Poland, the Czech Republic and several other countries relaxed their smoking bans (or introduced limited bans from the outset). The British media continues put out the message that the whole world is adopting the "comprehensive" smoking ban. The truth is that, along with the Irish, we have a ban that is exceptionally draconian, uncompromising and intolerant.

Friday, 7 October 2011

In the last eighty years, the proportion of household income spent on food has dropped from a third to less than a tenth. Fruit and vegetables from around the world are on the shelves all year round. Women are no longer chained to a life of domestic drudgery. Malnutrition and rickets are a distant memory. For the first time in history, we who are lucky enough to live in the West do not have to worry about food.

But worry we do – about genetic modification, fast food, BSE, childhood obesity, adult obesity, salt, margarine, cholesterol, fat, pesticides, red meat, food miles, carbon footprints and school dinners. At the very moment when we should be most relaxed about the food supply, we are bombarded with fears. Fast food is “addictive”, so we are told, and the food industry is trying to kill us for profit. Unless we take drastic action, most Britons will be obese by 2030.

As Rob Lyons patiently explains in this splendid plea for sanity, these beliefs owe more to ignorance and prejudice than fact. Take the humble hamburger, which obesity crusaders have chosen as their very own Moby Dick. On the face of it, it is bewildering why “two all beef patties, special sauce, lettuce, cheese, pickles, onions on a sesame seed bun”—to quote the old Big Mac slogan—should be the embodiment of evil. A burger is only bread, meat and salad. Each Big Mac contains 500 calories – a fifth of a man’s daily ‘limit’ - and you wouldn’t want to copy Morgan Spurlock’s silly experiment of eating nothing else, but it is no more fattening than the supposedly more wholesome alternatives. Ketchup is rich in vitamin C and so are fries - surprisingly, a portion of fries contains between a quarter and a third of an adult’s daily recommended vitamin C intake. There are better candidates for demonization in every middle class kitchen. “Cheese is roughly one third fat. Parmesan is also pretty salty. Olive oil is pure fat. Butter must be, by law, 80 per cent fat," writes Lyons. "Honey and raisins – usually regarded as ‘good’ – are practically pure sugar. Orange juice is 87 per cent water, almost all the rest is sugar.”

Although equally calorific, pasta is 'good', chips are 'bad'. Fizzy drinks are out, but fruit juice – though more sugary – is in. Whether measured by salt, sugar, fat or calorie content, there is little to distinguish ‘junk food’ from haute cuisine. Our perception of good and bad food has less to do with nutrition than it does with class. The dominant view of diet in modern Britain, Lyons argues, “has more to do with a combination of middle-class angst and plain old-fashioned snobbery than anything else.” If you are what you eat then junk food is for junk people. Oh, how we sneered at those ghastly common folk in Rotherham when they shoved fish and chips at their offspring through the school railings. Except that these ‘junk food mums’ - these ‘sinner ladies’ - were actually delivering meals, including sandwiches and jacket potatoes, which any adult would remember from their own school-days, and were only doing so because the school had operated a lunchtime lockdown to force the hapless children to eat Jamie Oliver’s low-fat fodder.

The Rotherham 'sinner ladies'

Jamie Oliver is the proverbial bad smell in Panic on a Plate, popping up with depressing regularity as the voice of the diet police. After making the transition from Sainsbury’s shill (catchphrase: “none of that low fat malarkey”) to canteen crusader, the TV chef turned a reasonable campaign for better school dinners into a witch-hunt against the “tossers” and “arseholes” who dared to give their offspring a packed lunch. Few images sum up the absurdity of the obesity panic than the stocky mockney berating stick-thin kids for eating chips. If you watched it with the sound turned off, Jamie's School Dinners was an hour long illustration of how few school children are overweight. Turn the sound up, however, and Oliver was saving these young 'uns from certain death.

Sausage, beans and chips might not be the most adventurous dish, but it is a perfectly nutritious lunch for active teenagers. With their boundless energy and growing bones, children burn off more calories than stout celebrity chefs. They also have naturally conservative palates, hence the nosedive in school dinners being served after the government capitulated to Oliver’s demands and substituted the much-despised Turkey Twizzlers for broccoli.

There is little that can be usefully said about food beyond the common sense observation that calories consumed should be roughly commensurate with energy expended. For the food faddists, it is not a question of excess versus exercise, but of wholesome food versus killer junk. Despairing of the "numpties" of Rotherham, Oliver could only sigh in exasperation: "If these mums want to effectively shorten the lives of their kids and others' kids, then that's down to them." Like many a culinary campaigner, Oliver is fond of repeating the grotesque lie that today’s children will die before their parents. Even when put in its less misleading form of ‘this generation will die at a younger age than their parents’, this reference to the ‘obesity timebomb’ remains unlikely and is belied by ever-increasing life expectancy estimates. Obesity is not going to bankrupt the NHS. Centenarians might.

The inevitability of parents burying their children in extra-large coffins is one of several oft-repeated ‘facts’ parroted by dietary dogmatists which do not stack up. Campaigners rarely acknowledge that obesity rates levelled off on both sides of the Atlantic ten years ago, and the claim that fast food is ‘addictive’ requires a definition of addiction that is so broad it would include any activity people find enjoyable. The claim that it is cheaper to buy 'junk food' than cook a meal at home is demonstrably untrue and the sainted Mediterranean diet has proved to be less healthful than was believed thirty years ago, while fears of salt, GM crops, BSE and manmade fertilisers have been shown to be greatly exaggerated when not utterly groundless.

The middle classes have been susceptible to food faddism since the Victorian era, when the ‘back to the land’ movement ignited the first stirrings of popular vegetarianism and organic farming. As the urban population began to outnumber that of the countryside, a romantic, idealised view of nature emerged which can be seen to this day in such eccentric organisations as the Soil Association and the Center for Science in the Public Interest. “The underlying temper of our times,” writes Lyons, “is that anything processed or industrialised can be seen as adulterated and harmful, while anything that appears to be natural or close to nature can be regarded as pure and uncorrupted.”

Jamie Oliver and his chins

The fetish for organic vegetables epitomizes this foodie flim flam. Study after study has found no health benefits from eating organic produce and even organic devotees are unable to distinguish one from the other in blind trials. Far from being led by the evidence, the organic movement is deeply suspicious of science. Fearful of the slightest trace of ‘chemicals’ and suspicious of industry, the organic/anti-GM crowd is backward looking and elitist (hello, Prince Charles). Over-priced and over-rated, organic food is little more than a tax on the credulous.

Just as Oliver yearned to return to the Golden Age of school dinners (no soggy semolina or concrete chips in his recollection), nostalgia for a bygone age of wholesome grub figures heavily in the modern war on fast and/or convenient food. “Don’t eat anything your great-great-grandmother wouldn’t recognize as food,” says the writer Michael Pollan. Mmm, all those handpicked vegetables and buxom maidens toiling over churns of butter. Jumpers for goalposts. Marvellous.

Or perhaps not. Your grandmother would probably not recognize spaghetti, hummus or kiwi fruits as food, but she would certainly be familiar with bread and dripping, gruel, fried everything and the early symptoms of scurvy. The range and quality of British food has improved immeasurably since the turn of the last century and supermarkets have broadened our horizons considerably. An illustration of this came when Delia Smith updated her 1970s cook books in 1995 and found that: “Almost everyone now has access to good olive oil, fresh herbs, imported cheese. I found myself over and over again deleting the words ‘or if you can’t get it…’” More choice, lower prices, less toil. What's not to like?

What the food faddists don't like is the modern world. After decades of lingering on the fringes of public life, lentil-munching hypochondriacs have now found an audience at a time when the micromanagement of private behavior is the raison d'etre of British politics. The public health establishment is gearing up for a legislative crusade of tax rises and advertising bans on food which is overtly based on the anti-smoking campaign. Big Food is already being wheeled out as the new Big Tobacco, and politicians who lack bigger ideas are happy to lead the assault against what they are told is a new ‘epidemic’. The food on our table will be targeted by law-makers and single-issue campaigners for many years to come. The myths and half-truths discussed in Panic on a Plate will be echoed often and loudly. Prepare yourself by reading this excellent book.

Thursday, 6 October 2011

It is a rare month when Stanton Glantz, doctor of mechanical engineering and professor of something-or-other at the University of San Francisco, does not publish some advocacy-based junk in a low-grade public health journal. The old fellow has many imitators these days, but efforts like this from the forthcoming issue of Tobacco Control show that he will not give up his crown without a fight.

Movies with smoking make less money

Stanton A Glantz, Jonathan R Polansky

Objective: To determine the relationship between presence of smoking in films and total box office receipts.

The conclusion of this study is rather given away by the title. By reviewing a whole load of films, Glantz found that movies which depicted smoking made l3% less money than those which didn't. The methodology was as follows:

...we compared the reported box office gross receipts (in 2010 dollars) of the 1316 films, with and without tobacco imagery, that ranked among the top 10 in ticket sales in any given week of their ‘domestic’ (USA and Canada) theatrical release between 2002 and 2010.

What a pitiful thought it is that someone in California has been paid to watch over a thousand movies to look out for a glimpse of tobacco smoke. And how tragic it is that Glantz keeps the resulting dossier in his office to be whipped out for studies like this. Nevertheless, the methodology is not unreasonable and we shall assume—possibly naively—that the basic conclusion is sound.

The question is: So what? No one has ever claimed that directors portray smoking to boost sales. It is an artistic decision which reflects a real world in which 1 in 5 people smoke. Surely Glantz is not going to insist—as he does with smoking bans—that cow-towing to tobacco controllers is going to be good for business?

Fear not, dear reader. Even Stan is not prepared to mistake correlation and causation so grievously (although it surely won't be long before advocates use this study to tell Hollywood: "Get rid of smoking in your films and you'll boost sales by 13%"). He does not claim that smoking in films is the cause of lower revenues. He does not explore what the actual reasons may be, but it seems likely that smoking is more common in indie films, gritty dramas, European releases and other movies which tend to make less money than big budget cartoons and family blockbusters.

Since there is no cause-and-effect here, what is the point of the study? For Stan, the point is that Hollywood has nothing to fear from his SmokeFree Movies ruse because a lack of smoking on the screen does not put off punters.

One hypothesis to explain the persistence of high levels of smoking in US films is that smoking pays off at the box office.

Er, no it isn't. As far as I'm aware, nobody has ever made such an argument and it is telling that Glantz does not provide a reference for this claim. Nobody seriously believes that people are specifically attracted to films which show smoking, nor is anyone deterred from seeing films which do show smoking. It's irrelevant at the business end. This is purely an issue of artistic freedom versus censorship.

Having constructed his straw man, Glantz demonstrates that it is false. Well done him. However, while he shows that tobacco imagery has no effect on box office takings, he inadvertently manages to show that his SmokeFree Movies scheme would financially damage the movie industry.

This study shows why movie studios tend to push for a PG-13 rating: such movies make 18% more at the box office compared ones with an R rating.

This is the real point of SmokeFree Movies. The purpose is not merely to restrict smoking in the movies to R rated films. The purpose is to coerce movie studios into getting rid of all smoking from their films for fear of losing their PG rating and, therefore, a significant proportion of their audience.

Under Glantz's regime, the makers of The Simpsons Movie or Avatar would have to think very carefully about whether they wished to maintain their artistic vision or maintain their PG rating. If they say "screw these cranks, the film stays as it is" then they will lose their PG rating and, therefore, will lose money—to the tune of 18%, according to Glantz, although this gap may not be entirely due the classification status.

What Glantz demonstrates in this study is that the presence or absence of smoking has no effect on box office takings (no one ever thought it did), but that the SmokeFree Movies plan will lead to a significant loss in box office takings if directors choose not to capitulate to the anti-tobacco fanatics.

Glantz, however, comes to exactly the opposite conclusion in his new study:

...implementing an R rating for smoking to remove it from youth-rated films will not conflict with the economic selfinterest of producer-distributors.

Garbage. R ratings have a negative effect on sales. The SmokeFree Movies plan will lead to more films being given an R rating. Therefore, the SmokeFree Movies plan will very much "conflict with the economic self-interest of producer-directors."

The only way to escape this financial damage will be for film-makers to remove every hint of smoking from their films. That is what Glantz wants, of course, but if they refuse—as they have every right to do—they will be penalised at the box office. This is blackmail, pure and simple. Comply or die. If directors refuse to cleanse their films to suit the zealots they risk losing millions of dollars. No wonder Hollywood has consistently told them to sod off.

About Me

Writer and researcher at the Institute of Economic Affairs. Blogging in a personal capacity.
Author of Selfishness, Greed and Capitalism (2015), The Art of Suppression (2011), The Spirit Level Delusion (2010) and Velvet Glove, Iron Fist (2009).

"Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end, for they do so with the approval of their own conscience."